| NPI | 1679629513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0990535-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 140944) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO RXN.0100732-NP) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-07-08 |